Improving lung cancer screening in a community healthcare system by electronic health record (EHR) optimization.
Authors: Sujith Puskoor, Jesse Mooneyham, John Nguyen, Robert Todd, George Germanos, Rakesh Surapaneni
Journal: Journal of Clinical Oncology (2022)

437 Background: In March 2021, the United States Preventative Services Taskforce updated its lung cancer screening guidelines to improve overall survival rates, decrease disparities and provide a net cost savings to the healthcare system. With many patients having advanced lung cancer at the time of their diagnosis, it is imperative that screening is performed as soon as applicable. The objective of this study was to improve documentation in EPIC to help prompt low-dose CT (LDCT) scan reminders for providers on the EHR. Methods: This was a prospective study that utilized patient data from EPIC from the Baylor Scott &amp; White Healthcare primary care clinic in Round Rock, Texas. Our version of EPIC used the guidelines prior to the 2021 change. To prompt a reminder on EPIC, there needs to be sufficient numerical data in the smoking history entry form to calculate the pack-years for a patient. EPIC will then automatically generate a notification for providers to order screening LDCT scans for patients that fulfill the screening criteria. We utilized “SlicerDicer” on EPIC to create a custom report of patients that qualified for the study in terms of the inclusion and exclusion criteria. From October 2021 to January 2022, we collected a pre-intervention representative sample to assess how well smoking had been documented during this period. We manually reviewed each medical record number (MRN) listed in the report to verify if proper documentation was used. Our intervention was to contact the clinic manager multiple times with specific instructions on proper smoking history charting. This was then distributed to all ancillary clinic staff via team meetings and flyers. We planned an intervention period from February 2022 to May 2022 that involved data totaling 1178 patients with similar abstraction methods as the pre-intervention data set. Results: We were able to increase lung cancer screening reminders on EPIC for this higher risk patient population. Specifically, 37% of patients pre-intervention had complete data compared to 49% of patients post-intervention. Therefore, an absolute difference of 12% (31.80% increase) of proper documentation was achieved to increase LDCT reminders. The most common mistake by staff was documenting smoking history into the free-text portion of the entry-data forms, which EPIC is not able to calculate pack-years from. Conclusions: Following the intervention at the outpatient clinic, we were able to boost LDCT reminders via an already established process. Increased reminders will eventually lead to more screening orders placed, which we plan to assess for in the next phase of our study. This study can be easily replicated at other centers by instilling similar clinical staff information sessions about documentation. Proper documentation by all healthcare providers is a shared responsibility that has both immediate and longer-lasting impacts on an individual and population level.